Excellent review of octreotide as an antidote for sulfonylurea overdose

November 29, 2012, 3:24 pm

★★★★☆

Octreotide for the treatment of sulfonylurea poisoning. Glatstein M et al. Clin Toxicol 2012;50:795-804.

Abstract

Sulfonylurea hypoglyemic medications such as glipizide and glyburide increase release of insulting from the pancreas, thereby lowering serum glucose levels. Octreotide, a synthetic somatostatin analog, has the opposite effect, inhibiting pancreatic insulin release through a different mechanism.

Episodes of hypoglycemia following sulfonylurea overdose can be prolonged, sometimes persisting for several days. Administering intravenous dextrose to treat these episodes promotes insulin release from the pancreas, causing recurrent hypoglycemia. Limited evidence suggests that treating these patients with intravenous or subcutaneous octreotide decreases both dextrose requirements and the number of hypoglycemic episodes.

This well-done literature-based review article is the most comprehensive discussion of its topic that I’ve seen. It is impossible to summarize without going on at chapter length, but some of the take-home lessons include:

  • Duration of hypoglycemia in overdose of some sulfonylurea agents can be up to 72 hours.
  • A single tablet of glipizide or glyburide can cause symptomatic hypoglycemia in infants or toddlers.
  • Risk factors fo sulfonylurea-induced hypoglycemia include young age, malnutrition, alcohol use, and kidney or liver disease.

The authors’ therapeutic recommendations are as follows:

Although relatively limited, the available data suggest that octreotide should be considered first-line therapy in both pediatric and adult sulfonylurea poisoning with clinical and laboratory evidence of hypoglycemia. . . . [S]erum glucose concentrations should be closely monitored (every hour) during treatment with octreotide and dextrose and for 16-24 hours after their cessation. In patients wit renal failure a longer observation period is warranted due to extensive renal elimination of most sulfonylurea compounds and impaired insulting clearance in renal insufficiency. Serial potassium concentrations should also be motored, especially in patients with renal failure or beta blocker treatment. Any recurrent hypoglycemia should be promptly treated with octreotide and IV dextrose.

Nothing new or earth-shaking, but worth reading.

2 Comments:

  1. Ð Says:

    Thanks for the article. I was wondering if there’s a role for octreotide in the non-overdosed patient with hypoglycemia secondary to sulfonylurea use? Would you considering using it if there’s recurrent hypoglycemia despite IV dextrose and adequate po intake?

  2. Leon Says:

    D:

    I would consider a patient with symptomatic hypoglycemia from a sulfonylurea toxic — even if there was no history of a specific overdose. A key point of the article — which I agree with — is that in these patients octreotide should be considered a first-line therapy, and if there is no contraindication it should be given when hypoglycemia requires any administration of IV dextrose.